Evidence of pressure on the neck forms a spectrum of degree from minimal to marked. We report a case of fatal pressure on the neck with minimal external signs. A 27 year old woman was found dead in her home. A blood stained knife and a blood stained bathrobe belt with hair entangled in it were discovered at the scene. Autopsy revealed a stab injury to the chest extending to the right lung and multiple contusions to the head, face and extremities. There were petechial haemorrhages on bilateral eyelids and conjunctivae. There were 2 small contusions on the front of the neck. Special neck dissection revealed a small haemorrhage in the sternocleidomastoid muscle and a haemorrhagic fracture of the right superior horn of the thyroid cartilage. Cause of death was given as pressure on the neck in a woman with stab injury to the right chest. Petechial haemorrhages play a major role in confirming the cause of death when there is minimal evidence for application of pressure on the neck.